Smokers are nearly three times as likely to get lower back pain. Smoking may aggravate abdominal pain and joint pain, as well. In fact, smoking may increase pain sensitivity in general.

About 18 percent of people in the United States are smokers, according to the Centers for Disease Control and Prevention. Yet smokers make up more than 50 percent of patients who seek pain treatment.

How smoking hurts

The nicotine in tobacco can trick the body into feeling good — at first. It triggers the release of chemicals, like dopamine, which give off a satisfying, “reward” sensation. It’s what makes smoking so addictive.

But that same tobacco also impairs the delivery of oxygen-rich blood to bones and tissues. Decreasing blood and nutrient flow can cause degeneration, particularly in discs of the spine, which already have more limited blood flow. The result can be lower back pain and sometimes osteoporosis.

Physicians also link smoking with fatigue and slower healing, factors that make painful conditions more prominent. Researchers are exploring even more physiological reasons why smoking makes people with fibromyalgia, arthritis and other chronic pain hurt more.

To make matters worse, when smokers suffer from debilitating pain, potentially life-changing treatments may not work.

“Smokers aren’t the best candidates for implantable devices such as neurostimulators, which block pain sensation,” says Dr. Barnett. “Smoking impairs the immune system and increases the risk of infection after surgery.”

How to get started

Dr. Barnett actively counsels patients to quit smoking. “You may look to cigarettes for help coping with pain, anxiety or stress, but there are healthier ways to do that,” he says.